What is the difference between anticoagulants and antiplatelet agents

Antiplatelet agents are a group of drugs that prevent blood clots.

They act at the stage of blood clotting, during which sticking, or aggregation, of platelets occurs. They inhibit (suppress) the process of gluing together blood platelets, and coagulation does not occur. Different drugs in this group have different mechanisms of action to obtain an antiplatelet effect.

Today, medicine uses both long-known blood thinners and modern drugs that have fewer contraindications and less pronounced side effects. Pharmacology is constantly working on new drugs, the characteristics of which will be better than those of the previous ones.

Why do you need to thin your blood?

Blood clotting is the result of a complex sequence of events known as hemostasis. It is thanks to this function that bleeding stops and blood vessels are quickly restored. This happens because tiny fragments of blood cells (platelets) stick together and “seal” the wound. The coagulation process involves as many as 12 coagulation factors that convert fibrinogen into a network of fibrin filaments. In a healthy person, hemostasis is activated only in the presence of a wound, but sometimes uncontrolled blood clotting occurs as a result of diseases or improper treatment.

This is what a blood clot looks like

Excessive clotting leads to the formation of blood clots, which can completely block blood vessels and stop blood flow. This condition is known as thrombosis. If the disease is ignored, parts of the blood clot can break off and travel through the blood vessels, which can lead to the following serious conditions:

• transient ischemic attack (mini-stroke);
• heart attack;
• gangrene of peripheral arteries;
• infarction of the kidneys, spleen, intestines.

Thinning the blood with the right drugs will help prevent the occurrence of blood clots or destroy existing ones.

What are antiplatelet agents and how do they work?

Antiplatelet drugs suppress the production of thromboxane and are prescribed to prevent stroke and heart attack. Drugs of this type inhibit platelet aggregation and blood clot formation.

Aspirin is one of the most inexpensive and common antiplatelet drugs. Many patients recovering from a heart attack are prescribed aspirin to stop further blood clots forming in the coronary arteries. In consultation with your doctor, you can take low doses of the drug on a daily basis to prevent thrombosis and heart disease.

Aspirin is the most common antiplatelet drug

Adenosine diphosphate (ADP) receptor inhibitors are prescribed to patients who have had a stroke or those who have had a heart valve replacement. Glycoprotein inhibitors are injected directly into the bloodstream to prevent blood clots from forming.

Antiplatelet drugs have the following trade names:

• dipyridamole,
• clopidogrel,
• nugrel,
• ticagrelor,
• ticlopidine.

ADP blockers

Agents that reduce the effect produced by a special substance - adenosine phosphate. This compound provokes platelet clumping through a complex bond with fibrinogen, therefore drugs of this type affect the fundamental processes of thrombus formation.

Moreover, unlike the previous ones, they are more selective and are used with less caution, although they can cause harm if used incorrectly.

Ticlopidine

A relatively old, well-studied name. The product was first synthesized in the late 70s of the last century. It is still actively used, represented by a list of trade names: Tiklid, Tiklo, Aklotin, Tagren.

The drug is used both as part of urgent care for emergency conditions, and for the treatment of chronic diseases associated with a violation of the rheological properties of the blood.

Basically, the medication is prescribed for the purpose of treating long-term conditions, preventing dangerous complications, and thrombosis. The question is open and remains at the discretion of the doctor.

Clopidogrel

There is no consensus in the medical community about what is more effective, this name or Ticlopidine. The authors hold different points of view.

However, practitioners agree that before and after surgical interventions, especially for cardiac diseases, preference should still be given to Clopidogrel, as it is the optimal combination of effectiveness and safety.

It is not prohibited to use the pharmaceutical product either in emergency conditions or for a long time, depending on the indications.

In any case, both names have significant potential and can be dangerous if used incorrectly.

Medicines to reduce the effect of ADP are also taken in isolation, as the main ones in therapy. Especially in mild cases, but more often prescribed in a system with others. Depends on the situation.

Side effects of antiplatelet drugs

Like all other medications, taking antiplatelet drugs can cause unwanted effects. If the patient experiences any of the following side effects, it is necessary to ask the doctor to review the prescribed medications.

Antiplatelet drugs have many side effects

The following negative manifestations should alert you:

• severe fatigue (constant fatigue);
• heartburn;
• headache;
• upset stomach and nausea;
• abdominal pain;
• diarrhea;
• nose bleed.

Side effects that require you to stop taking medications if they occur:

• allergic reactions (accompanied by swelling of the face, throat, tongue, lips, hands, feet or ankles);
• skin rash, itching, urticaria;
• vomiting, especially if the vomit contains blood clots;
• dark or bloody stools, blood in the urine;
• difficulty breathing or swallowing;
• speech problems;
• fever, chills, or sore throat;
• fast heartbeat (arrhythmia);
• yellowing of the skin or whites of the eyes;
• joint pain;
• hallucinations.

It is possible that some patients will be prescribed antiplatelet medications for the rest of their lives. These patients will need to have regular blood tests to monitor their clotting time.

Contraindications

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The same applies to these grounds. The list of antiplatelet drugs is wide; it is impossible to give a complete list without taking into account the specifics of the pharmaceutical product. That's why the abstract is taken.

If we talk about something approximate again:

• Breast-feeding. The active ingredients are transmitted through milk, so use is strictly prohibited.
• Pregnancy in any phase. Will affect the condition of the mother or fetus.
• Age up to 18 years. Contraindication for the predominant number of antiplatelet agents. Use not allowed
• Hemorrhagic stroke, in which bleeding develops into the structures of the brain.

• Heart failure, at any stage. Absolute contraindication.
• Hepatic or renal dysfunction in the active phase, until the condition is compensated. Then - with great care and prudence.
• Ulcer of the stomach, duodenum, mucous membrane of other parts of the digestive tract. Because it is possible to develop bleeding, even fatal.

Even in the absence of clear reasons for refusing use, you need to carefully think about the advisability of using the medication.

Features of the action of anticoagulants

Anticoagulants are medications prescribed to treat and prevent venous thrombosis and prevent complications of atrial fibrillation.

The most popular anticoagulant is warfarin, which is a synthetic derivative of the plant material coumarin. The use of warfarin for anticoagulation began in 1954, and since then the drug has played an important role in reducing mortality in patients prone to thrombosis. Warfarin suppresses vitamin K by reducing the hepatic synthesis of vitamin K-dependent clotting factors. Warfarin drugs are highly protein bound, which means that many other medications and supplements can alter the physiologically active dose.

The dose is selected individually for each patient, after carefully studying the blood test. It is strongly not recommended to change the selected dosage of the drug on your own. Too much of a dose will mean that blood clots do not form quickly enough, increasing the risk of bleeding and non-healing scrapes and bruises. A dosage that is too low means that blood clots can still develop and spread throughout the body. Warfarin is usually taken once a day, at the same time every day (usually before bed). Overdose may cause uncontrolled bleeding. In this case, vitamin K and fresh frozen plasma are administered.

Warfarin is the most popular anticoagulant

Other drugs with anticoagulant properties:

• dabigatran (Pradacas): inhibits thrombin (factor IIa), which prevents the conversion of fibrinogen to fibrin;
• rivaroxaban (Xarelto): inhibits factor Xa, preventing the conversion of prothrombin to thrombin;
• Apixaban (Elivix): also inhibits factor Xa and has weak anticoagulant properties.

Compared to warfarin, these relatively new drugs have many advantages:

• prevent thromboembolism;
• lower risk of bleeding;
• fewer interactions with other medications;
• shorter half-life, which means it will take a minimum of time to reach peak levels of active substances in plasma.

Herbal remedies

Their pharmacological effectiveness has not been proven. These are medicines based on Ginkgo Biloba.

Such “medicines” do not make much sense in purchasing and using them for their intended purpose.

This also includes conventionally “folk” recipes based on ginger, St. John’s wort and others. This is not a treatment, just an amateur activity.

Herbs can be used as an aid only if the doctor agrees to it. Therapy does not tolerate creativity; it requires common sense, accurate calculations and analytical work.

Side effects of anticoagulants

When taking anticoagulants, side effects occur that differ from the complications that may occur when taking antiplatelet drugs. The main side effect is that the patient may suffer from prolonged and frequent bleeding. This may cause the following problems:

• blood in urine;
• black feces;
• bruising on the skin;
• prolonged nosebleeds;
• bleeding gums;
• vomiting blood or coughing up blood;
• long menstruation in women.

But for most people, the benefits of taking anticoagulants outweigh the risk of bleeding.

GPR blockers

Agents that reduce the sensitivity of platelet glycoprotein receptors act mildly and are relatively rarely tolerated.

The basis of the influence of medications of this type is the ability, relatively speaking, to instruct platelets not to interact with factors that provoke aggregation, that is, their sticking together.

The rheological properties of blood change slightly; the effect of HPR blockers is high, but short-lived. Therefore, it makes sense to use the remedy either within the framework of acute conditions or to select a clear regimen and dosage.

Among the names are Eptifibatide (Intergrilin), Tirofiban, and others.

Medicines of this type are most widely used when used in patients with acute conditions in a hospital. For example, with coronary insufficiency.

It also makes sense to use them in a system with classical medications based on Aspirin.

What is the difference between anticoagulants and antiplatelet agents?

Having studied the properties of the two types of drugs, we can come to the conclusion that they are both designed to do the same job (thin the blood), but using different methods. The difference between the mechanisms of action is that anticoagulants usually act on proteins in the blood to prevent the conversion of prothrombin to thrombin (the key element that forms clots). But antiplatelet agents directly affect platelets (by binding and blocking receptors on their surface).

When blood clots, special mediators released by damaged tissues are activated, and platelets respond to these signals by sending special chemicals that provoke blood clotting. Antiplatelet drugs block these signals.

Acetylsalicylic acid

And its derivatives. The most common group of pharmaceuticals in medical practice with high proven effectiveness.

When compared to the other types described below, these drugs are about average in safety and effectiveness.

The classic and long-outdated Aspirin is currently still actively used, despite the high risks.

It does a good job of urgently restoring blood flow, but is absolutely not suitable for long-term use. As part of modern practice, its safer analogues are prescribed.

Aspirin-Cardio

Perhaps the most popular modification of the drug based on acetylsalicylic acid. It has a different dosage than its predecessor and is positioned as a means for the systemic, complex treatment of cardiovascular diseases.

Whether this is true or not, doctors have not come to a consensus. The main feature of Aspirin-Cardio is the possibility of long-term use with fewer risks to health and life.

The antiplatelet effect is achieved after several days of use, so the product can be considered relatively safe.

At the same time, in addition to restoring the rheological properties of liquid connective tissue, Aspirin-Cardio relieves inflammation, pain, and normalizes body temperature.

Such non-selectivity can play a cruel joke; you need to be careful when using it and carefully monitor your own feelings.

The concentration of acetylsalicylic acid in this drug is three times higher than in the classic variation of Aspirin, which also imposes a lot of restrictions. All issues are resolved at the discretion of the treating specialist.

Thrombo-ASS

In fact, there is no big difference between the old analogues based on acetylsalicylic acid and this name. In both cases, the concentration of the active substance is identical.

The difference lies in the form of release. The coating of the drug Thrombo-ACC prevents the rapid absorption of acid in the digestive tract and reduces the destructive effect of this phenomenon.

Therefore, the medication is considered not so aggressive towards the organs of the gastrointestinal tract. The advantage is quite controversial, taking into account the mass of analogues of other groups, as well as the higher cost of Trombo-ACC.

In any case, the issue of choice and appointment is decided by doctors. Unauthorized use is not possible if there is a desire to preserve health.

Aspicor

It has a minimal dosage of acetylsalicylic acid, in addition, it is considered safer than aspirin-containing analogues, not as aggressive and “clean”, therefore it can be used indefinitely as a maintenance treatment. But not in the “role” of the only medicine, but in the system.

The cost of Aspicor also makes the drug simple and affordable, because the price is not much different from that of a regular obsolete analogue.

In all cases, medications based on acetylsalicylic acid have a significant disadvantage. They are not selective.

The antiplatelet effect is complemented by an anti-inflammatory and antipyretic effect; it is logical that the drug affects many functions and organs, including the digestive tract and heart.

If used excessively, it can cause bleeding and increases the fragility and permeability of blood vessels.

Precautions when taking blood thinners

If anticoagulants or antiplatelet agents are prescribed (sometimes they can be prescribed in combination), then it is necessary to periodically undergo a blood clotting test. The results of this simple test will help your doctor determine the exact dose of medications to take each day. Patients taking anticoagulants and antiplatelet drugs should tell dentists, pharmacists, and other health care providers about the dosage and timing of medications.

It is necessary to inform doctors if you are taking blood thinning medications.

Because of the risk of severe bleeding, anyone taking blood thinners should protect themselves from injury. You should avoid playing sports and other potentially dangerous activities (hiking, motorcycle riding, active games). Any falls, strong impacts or other injuries should be reported to your doctor. Even minor trauma can cause internal bleeding, which may occur without any obvious symptoms. Particular attention should be paid to shaving and brushing your teeth with special floss. Even such simple everyday procedures can lead to prolonged bleeding.

Natural antiplatelet agents and anticoagulants

Some foods, dietary supplements and herbs have blood thinning properties. Naturally, they cannot be supplemented with medications already taken. But in consultation with your doctor, you can use garlic, ginger, ginkgo biloba, fish oil, and vitamin E.

Garlic

Garlic is the most popular natural remedy for the prevention and treatment of atherosclerosis and cardiovascular diseases. Garlic contains allicin, which prevents platelets from sticking together and forming blood clots. In addition to its antiplatelet effects, garlic also lowers cholesterol and blood pressure, which are also important for cardiovascular health.

Ginger

Ginger has the same beneficial effects as antiplatelet medications. You need to consume at least 1 teaspoon of ginger every day to notice the effect. Ginger can reduce the stickiness of platelets and also lower blood sugar levels.

Ginkgo biloba

Consuming ginkgo biloba can help thin the blood and prevent platelets from becoming too sticky. Ginkgo biloba inhibits platelet activating factor (a special chemical that causes blood to clot and form clots). Back in 1990, it was officially confirmed that ginkgo biloba effectively reduces excessive platelet adhesion in the blood.

Natural supplements will also help prevent the development of thrombosis

Turmeric

Turmeric can act as an antiplatelet drug and reduce the tendency to form blood clots. Some studies have shown that turmeric may be effective in preventing atherosclerosis. An official medical study conducted back in 1985 confirmed that the active component of turmeric (curcumin) has a pronounced antiplatelet effect. Curcumin also stops platelet aggregation and also thins the blood.

But it is better to avoid foods and dietary supplements that contain large quantities of vitamin K (Brussels sprouts, broccoli, asparagus and other green vegetables). They can dramatically reduce the effectiveness of antiplatelet and anticoagulant therapy.

Arachidonic acid production inhibitors

Reduce the rate of synthesis of the named substance. In general, they are similar to the previous group of medications with an antithrombotic effect. The difference is selectivity.

This category of drugs affects many factors of platelet “clumping”, and therefore poses a much greater danger to the health and life of the patient than others.

When using it, you need to constantly monitor the person’s condition over time. To quickly adjust the dose or discontinue the drug.

Among the names: Indobufen, Ibustrin and others.